As part of our efforts to monitor access to the COVID-19 vaccines for undocumented migrants in Europe, we’re speaking with national-level advocates about the situation in their countries. This interview was conducted in May 2021 with Linnea Näsholm of Oslo Health Centre for Undocumented Migrants and Katrine Meisfjord from the Bergen Health Centre for Undocumented Migrants to discuss the situation in Norway. It is not meant to offer an exhaustive picture of the legal and practical context in Norway. Please get in touch at info@picum.org if you have information you’d like to share, and follow our Twitter page @PICUM_post to get more recent updates.

What does the Norwegian vaccination strategy say about undocumented people?

Undocumented migrants are not mentioned explicitly in the Norwegian vaccination strategy. The strategy rather focuses on age and medical conditions as criteria to prioritise groups of people in the vaccination campaign.

Are there any other relevant policies that indicate undocumented people are included in the vaccination campaign?

Yes. The law on communicable disease entitles everyone, regardless of residence status, to health care related to communicable diseases, including treatment and preventative care, like vaccinations.

In addition, in early spring 2021, the Norwegian Directorate of Health published guidance on COVID-19-related care for undocumented people. It addressed a letter to all local and regional health authorities, both primary and specialist healthcare services, calling on them to make the vaccines available for everyone. However, the letter did not detail how undocumented people could practically get their shot. It really passed the buck to the municipalities in terms of how to organise this.

Do you mean that undocumented people can’t just book their vaccine like everyone else?

Indeed. In Norway, as a rule, undocumented people can only access emergency health care and “health care that is totally necessary and cannot be deferred”. For other types of care, except when related to children and pregnant women, you need to have a valid personal identification number and be registered with a GP, which is by law not possible for undocumented migrants. Informal access to a GP may still be possible, but then the doctor has to bear all the costs of the care they provide. The letter from the Directorate of Health stated access to the vaccines for all but didn’t say how undocumented migrants could practically get their appointment and then their shot.

Let’s look at the booking system. How does that work in Norway, and what does that mean for undocumented people?

It depends on the local health authority’s approach. In some localities, you are contacted by the local health authority to get an appointment for your vaccine after your GP sends your contacts to the local vaccination centre. Some other health authorities provide the vaccine at the GP clinic. In both cases, you need to be registered with a GP. And for that, you need a valid identification number, which means you have a valid residence permit.

In Oslo, the Health Centre for Undocumented Migrants, in collaboration with the municipality, arranged for a local GP to come once a week to write referrals for people based on their medical and socio-economic conditions. With these referrals, undocumented people can be called to get their vaccine without the need of a personal number or a valid ID document: only the name, date of birth, phone number and preferred language are noted. We have very good cooperation with one of the local vaccination centres in Oslo, we work together to make sure people get appointments and access to interpretation. They even suggested coming to our health centre or having a specific day just for referred patients in case this could be helpful.

It looks like everything is left to the goodwill of the municipalities. Are there other good practices from local authorities?

Yes, in Bergen, for instance, the municipality is employing a GP who works with grassroots organisations to make sure vulnerable groups are vaccinated. Vaccinations for undocumented people are in practice organised by the Health Centre for Undocumented migrants in Bergen.

Are there any concerns regarding the sharing of personal data with immigration authorities?

In Norway, there’s a very clear firewall and medical staff have a strong duty of confidentiality. We’ve had few cases where immigration authorities called a doctor about patients to be deported, to check when they’d be fit to fly. When that happens, medical staff have a duty to keep confidentiality. It’s illegal for medical staff to report undocumented patients.

Cover: Avonne Stalling – Pexels

As part of our efforts to monitor access to the COVID-19 vaccines for undocumented migrants in Europe, we’re speaking with national-level advocates about the situation in their countries. This interview was conducted in April 2021 with Vivien Vadasi of Menedék to discuss the situation in Hungary. It is not meant to offer an exhaustive picture of the legal and practical context in Hungary. Please get in touch at info@picum.org if you have information you’d like to share, and follow our Twitter page @PICUM_post to get more recent updates.

What does the Hungarian vaccination strategy say about undocumented migrants?

The Hungarian strategy is a very short document that describes the order of vaccination, in terms of priority groups, but doesn’t mention at all undocumented migrants, or foreigners for that matter. Last February, we asked the government to clarify who’s eligible for the vaccination and what are the plans to reach out and provide vaccinations to foreigners in Hungary. They replied that they’ll propose legislation on this, but it hasn’t happened yet.

Would undocumented migrants still be able to access the vaccines in practice? How does the registration work?

Registering for the vaccines can be done online. The website, which is only in Hungarian, requires a home address, which can be hard to impossible for undocumented migrants to prove.

As of May 4, foreigners living in Hungary without a social security number (TAJ) can register for their vaccines too. But details of residence papers and identity documents are also asked, but it doesn’t look mandatory to fill in those fields. We do know however, from official sources, that the registration data would be checked against the data in the immigration register. This obviously poses great risks for undocumented migrants.

OK, let’s start with the home address. How does that work?

Well, you could theoretically type a fake address online and get your appointment, but at the vaccination centre they’ll ask for a proof of address. Homeless people can get a “territorial address” card, which indicates what district they usually live in, and produce this at the vaccination point. But this card isn’t accessible for all migrants, let alone undocumented migrants. It is also not possible to use an NGO address as a replacement.

So home address is a huge barrier already. What about the social security number?

In Hungary, a social security number is issued for Hungarian nationals, EU nationals and their family members, permanent residents and beneficiaries of international protection. People with work-related residence permits, thus contributing to social security, can also get one. But their family members, or students paying their own fees can only get a social security number if they’re contributing ten times as much as the mainstream population for 25 months. So most of them end up buying private health care insurance. Undocumented people do not qualify for a social security card either as one of the conditions is the (legal) residence in Hungary.

Recent legislation introduced even stricter rules to access social security. Now, if you don’t pay social security contributions for the equivalent of six months, your social security number becomes invalid. The government has clarified that people with an invalid social security number can still access the vaccines, but the question remains for those who don’t have any such number.

Again, when trying to register for your vaccine online, in theory, you could insert a string of 0s in the social security number case as a workaround. You’d be able to book your appointment, but at the vaccination centre you’ll be asked for your social security number, nonetheless.

Right. So undocumented migrants wouldn’t be able to provide either a home address or a social security number.

Indeed. By design, undocumented migrants aren’t able to get the vaccines. In addition, at the vaccination point, you would also be asked for an identification document, that is an ID card for Hungarians and a residence permit for non-national residents, which is one more obstacle for undocumented migrants.

Is immigration enforcement involved at any point when trying to access the vaccines?

In general, health professionals aren’t required to inform immigration enforcement authorities of the migration status of patients. But in practice, the social security number and card remain a pre-condition to receive medical treatment, beyond urgent life-saving care.

1. The Hungarian strategy provides for a priority list (that is in practice not respected) of people who should receive the vaccination:
   1.Healthcare workers (including students at medical universities and all of those who work in the sector, i.e. cleaners as well)
   2. Professionals in the social care sector and beneficiaries of social care (while this category seems to be very inclusive, in practice, the government focused on social and care workers working in homes of the elderly and also those elderly who are placed in these homes. Nevertheless, also workers and inhabitants of homeless shelters received vaccination in some cases.)
   3. People aged 60 years or older who fall in the high-risk group due to their health condition
   4. Staff of the law-enforcement and government authorities (police, including border police and the immigration authority, administrative officials, etc.) who are in direct contact with the population
   5. People aged 16/18-59 living falling in the high-risk group due to their health condition
   6. Professionals working in the critical infrastructure (there was not much information about what sectors fall in that category)
   7. The rest of the population who do not fall in the categories above
   The priority list also lays down that the vaccination of people falling in category 2 and 4 should not depend on their registration on the official website but should be organized separately (on the contrary, my social worker colleagues had to register on the official website in order to be able to receive the vaccination). Category 1 also received vaccination independently from the official online registration system.

Cover: Abode Stock – EdNurg

As part of our efforts to monitor access to the COVID-19 vaccines for undocumented migrants in Europe, we’re speaking with national-level advocates about the situation in their countries. This interview was conducted in April 2021 with Anna Miller of Doctors of the World UK to discuss the situation in the UK. It is not meant to offer an exhaustive picture of the legal and practical context in the UK. Please get in touch at info@picum.org if you have information you’d like to share, and follow our Twitter page @PICUM_post to get more recent updates.

What does the UK vaccination strategy say about undocumented people?

The government says that the COVID-19 vaccines are accessible to everyone, including undocumented migrants, for free and without immigration checks. This is reflected in official guidance too.

So, all good?

Not really. There are still a number of challenges for undocumented people to actually get vaccinated against COVID-19. Starting with getting registered with a GP.

How do you register with a GP?

To get a vaccine, you need to book an appointment. You can do this either online or by calling your GP. The problem with the online registration is that you need an NHS (National Health Service) number, which lots of undocumented migrants don’t have.

How do you get one?

There are different ways. In some cases, you can get one automatically, for instance if you’re born in the UK, irrespective of your migration status. Or if you come to the UK on a visa for 6 months, you’ll have to pay a contribution to the NHS (the “immigration health charge”) and you’ll get an NHS number.

But most undocumented migrants don’t fall under these groups, and the only way they can get the number is through a GP.

What does that involve?

When you first go to the GP, and you don’t have an NHS number, the GP will request one for you, which you should be able to get in 14 days. But GPs routinely ask for proof of address or identity or immigration status, which can be hard if not impossible for undocumented migrants to produce. Government guidelines do say that the lack of those documents can’t be a ground for refusal, but in practice some GPs refuse to register people without those proofs. This is a huge issue.

What does this mean for access to the COVID-19 vaccines?

It means that if the GP refuses to register you, you won’t get your NHS number and you won’t be able to book an appointment for your COVID-19 vaccine.

How can this be solved?

We’ve been asking the government and the healthcare service to raise awareness among GPs about the paper requirements for registration, but most communications campaigns instead focuses on the patients. In England, for instance, NHS England has produced a card with the NHS logo for GP registration, which says that no document is required. Basically, it’s a self-advocacy tool. But it has limited impact, as the process for registering with a GP mostly happens online these days. And the online registration system still requires you to provide proof of address or identity.

Several Filipino care workers, who would be eligible for the COVID-19 vaccines because of the work they do, told us they tried to register with a GP online but didn’t manage to because of those requirements.

There are good practices, though, among doctors and clinics. Some local primary care networks are proactively doing outreach to people who haven’t come forward for vaccination and are eligible. Sometimes it’s outreach in asylum accommodation centres, or hotels used for confinement during lockdown for homeless people. But all of this work is driven locally, rather than coming from the government, so there is variation from region to region.

Let’s say an undocumented person was lucky enough to encounter an enlightened GP and get an NHS number, and an appointment for the vaccine. Will they need to show anything else at the vaccination centre?

Your booking reference number should be enough. But we’ve heard of cases where the vaccination centres asked for some proof of identity. The feeling is that this is due to sheer lack of awareness from the administration, we haven’t heard of cases where people were refused vaccination at the centre because they didn’t have those documents.

Since 2012, the UK government introduced a set of policies, known as “hostile environment”, that aim to make life unbearably difficult in the UK for those who cannot show the right paperwork.  How does this play into access to the vaccines?

This is a key point. The policy on access to the vaccines may be quite progressive on paper, but it’s implemented against the backdrop of years of policies that have eroded the trust of migrant communities in public authorities including the healthcare system. This includes the practice of sharing patient’s personal information with the Home Office, which is then used to carry out immigration enforcement activities.

Do health care providers share patients’ information with immigration authorities?

Patient data collected by primary care services used to be shared with the Home Office, because of a mechanism that existed between 2017 and 2018. The policy stopped but the fear around that is still very much there.

Secondary care services routinely share information about migrants with insecure immigration status with the Home Office. This results in people from migrant communities not trusting any type of healthcare services, including primary care ones.

We’ve long been asking the government to make all health care services safe and confidential for migrants and to communicate clearly about the prohibition of data sharing with immigration enforcement. So far, our calls have largely been ignored.

Cover: Ugur Akdemir – Unsplash

As part of our efforts to monitor access to the COVID-19 vaccines for undocumented migrants in Europe, we’re speaking with national-level advocates about the situation in their countries. This interview was conducted in April 2021 with Katarzyna Słubik of Stowarzyszenie Interwencji Prawnej (Association for Legal Intervention) to discuss the situation in Poland. It is not meant to offer an exhaustive picture of the legal and practical context in Poland. Please get in touch at info@picum.org if you have information you’d like to share, and follow our Twitter page @PICUM_post to get more recent updates.

Are undocumented migrants mentioned in Poland’s vaccination strategy?

The Polish vaccination programme is very vague, and doesn’t mention undocumented migrants. Official guidance does seem to limit access to the vaccinations to people who are regularly residing, which would de facto prevent undocumented migrants from accessing the vaccines.

So undocumented people can’t get vaccinated against COVID-19 in Poland?

It’s complicated. While the vaccination strategy seems to exclude undocumented people, our law on infectious diseases opens up to everyone in Poland health care related to infectious diseases. Under this law, you don’t need to have a national registration number, or be insured, to access health care related to the infectious disease. The law would apply to COVID-19 too, as it’s an infectious disease. But as for vaccinations, the law only mentions compulsory ones (i.e. childhood vaccines), while COVID-19 vaccines are not compulsory.

At the same time, the Ministry of Health has stated that the vaccines would be available for people who aren’t covered by health insurance. This would theoretically include undocumented people.

So it’s all very unclear. The Polish Ombudsman actually sent a letter to the government asking to clarify entitlements for migrants, but they haven’t got any response yet.

Have you heard of any undocumented people trying to get a COVID-19 vaccine?

We haven’t heard of any such cases. On the contrary, the feeling is that undocumented migrants are quite hesitant about the vaccines. On the one hand, there’s a major problem with health-related misinformation on vaccines among several communities, including the Ukrainian communities, Roma communities, asylum-seekers and undocumented migrants. On the other, there’s also an underlying fear of contacting doctors or authorities more generally.

How do you explain this fear among undocumented migrants?

In Poland, public institutions are obliged to cooperate with border police. What this means in practice for health authorities is quite unclear, in fact there’s a lot of confusion among medical staff.

While the law only regulates cases where border police can reach out to health providers for specific information, medical staff sometimes interprets it as an obligation to proactively report undocumented migrants. For instance, we’ve heard of hospitals reporting undocumented patients when they weren’t able to pay for the care they received.

Cover: Pexels- Julia Vol

As part of our efforts to monitor access to the COVID-19 vaccines for undocumented migrants in Europe, we’re speaking with national-level advocates about the situation in their countries. This interview was conducted in March 2021 with Christoph Krieger of Medibüro Kiel to discuss the situation in Germany. It is not meant to offer an exhaustive picture of the legal and practical context in Germany. Please get in touch at info@picum.org if you have information you’d like to share, and follow our Twitter page @PICUM_post to get more recent updates.

Does Germany include undocumented migrants in its vaccination campaign?

There is little information at this stage, but no federal plan currently explicitly mentions undocumented migrants as a target group of the German vaccination campaign. Some local authorities, including in Kiel, have shown a certain openness – in principle – to vaccinating undocumented migrants as long as they meet age or health-related eligibility requirements.

At the same time, federal regulations on the vaccination strategy state that you have to either provide a registered address or at least prove that you live in Germany “under normal circumstances”, which is meant to exclude those coming to Germany specifically to get their vaccine. Undocumented migrants in many cases can’t provide a registered address, but they might be able to provide a self-certification to prove that they live in Germany.

So undocumented migrants can get the vaccine through this self-certification?

This is where it gets tricky. In Germany, undocumented migrants risk immigration consequences if they try to get non-emergency health care because our federal residence law requires the governmental body they have to go through to report undocumented patients to immigration authorities. This means that they could risk detention and deportation if they register for their vaccine.

Let’s go step by step. How would it work in practice for an undocumented person who tries to access a vaccine?

First, they would get an appointment by internet or by phone. If they meet the eligibility requirements, they would be invited to the local vaccination centre.

Once there, they would need to show an identity card or passport, not necessarily German. So it would be possible to register with a Brazilian passport, for instance.

However, they would need to show a health insurance card too. If they don’t have a health insurance card, which is the case for undocumented migrants, they would need to go to the local social welfare office and get a paper confirming that the office will pay for the vaccination. This is how it works for homeless people, for instance. Some states don’t require a health insurance card – but need proof of residence in that state, which itself is a barrier for many.

But not for undocumented migrants?

No. If undocumented people go to the social welfare office, they risk being reported to immigration authorities because of art. 87 of the Residence Act.

Germany also has a large refugee population. Are there any differences in access to the vaccines for them?

Refugees can access health care almost on the same basis as German citizens. Those who live in refugee centres are actually prioritised in the vaccination campaign. The same goes for those asylum-seekers who’ve seen their asylum request rejected. In Germany, these people get a “tolerated status”, Duldung, whereby they can access certain health care for a period of time. This includes access to the COVID-19 vaccines.

Updates from April 2021:

Following a written request introduced by German MP Klein-Schmeink (Greens), the Ministry of Health clarified in a letter that undocumented people too are entitled to the COVID-19 vaccines, as long as they are habitually living in Germany. However, Doctors of the World note that concerns and practical issues remain, most notably around providing proof of habitual residence and around data sharing with immigration enforcement.

Since April 2021, people in Germany can get vaccinated at a doctor’s office. Here, one has to show proof of cost coverage for the 20€ that the doctor gets for administering the vaccination (health insurance or other source). Undocumented migrants cannot get a proof of cost coverage from the welfare office without being reported. In theory, they could pay the 20€ themselves/out-of-pocket. In this case, doctors are not obliged to report the undocumented patient to immigration authorities. Most cities’ administrations have stated that lack of proof of cost coverage (e.g. a health insurance card or the confirmation from the welfare office) should not keep anyone from getting vaccinated. In practice, however, doctors’ offices will be hesitant to vaccinate someone without proof of identity due to administrative difficulties.

Cover: Federico Orlandi – Paxels

Last updated: July 2021

Are COVID-19 vaccines available for undocumented migrants in Europe? International and EU bodies have recommended addressing marginalised communities, including migrants in situations of vulnerability, in national vaccination strategies. In Europe, however, national approaches vary a lot.

For undocumented people, who are excluded from the health systems of most European countries, the pandemic and the lockdown measures have exacerbated pre-existing conditions of social exclusion and destitution. Several European countries, regions and cities adopted measures to support this population during the pandemic, including through targeted regularisation programmes. But what is being done with regards to the vaccination campaign, one of the most important tools we have to protect people against COVID-19?

We have been monitoring the news and exchanging with our members and followers, and we have compiled a map that looks at two critical factors affecting access to the COVID-19 vaccines in Europe for undocumented migrants: the absence of administrative barriers and protection from immigration control consequences of getting the vaccines.

As for administrative access, we consider in particular whether it is possible for undocumented migrants to register for or otherwise get their vaccination without the need to give proof of residence or identity or other documents that many undocumented people simply cannot provide (for instance, a social security number).

As for protection from immigration control, we consider whether there are clear safeguards (“firewalls”) against exposure to immigration control, through data protection and freedom from checks or arrest at vaccination centres.

This map focuses on delivery of the COVID-19 vaccines and doesn’t provide information about the accessibility of other health care more generally in a country, which in most parts of the EU remains very restricted for undocumented people. This map is a living document, which we’re updating as national policies and practices evolve, and as more information becomes available.This map is based on information we’ve been able to gather so far, and we’ll keep updating it as we know more. Here’s a quick rundown of what we’ve learned:

Belgium

In early January, Brussels health minister Alain Maron said that “It’s out of question to exclude undocumented people from the vaccination process”. After this very welcome statement from a regional (Brussels) leader, the federal health minister confirmed before the Parliament that the vaccines would be available to undocumented migrants too. The Minister discussed the possibility of vaccinating this group via mobile medical teams, who would also ensure the vaccination for homeless people.

Finland

At the start of March, the Finnish Ministry of Social Affairs and Health recommended municipalities to grant access to the COVID-19 vaccines to undocumented migrants, free of charge. Questions remain as to the practical implementation of this recommendation.

France

The French health ministry has declared that the vaccines will be available to all people living in France, regardless of residence status. In practice, the vaccines will be free for all and no health insurance card will be required.

Germany

Although some German states have shown a willingness in principle to include undocumented migrants in their vaccination plans, no federal plan has stated explicitly that this group would be included. Moreover, federal regulations exist which require proof of residence in Germany in order to receive the vaccine.

See our blog post for more information on access to the vaccines for undocumented migrants in Germany.

Hungary

The Hungarian vaccination strategy does not mention undocumented migrants. The vaccination booking system requires both a valid social security number, which is not available for undocumented people, and a registered home address, which can be very difficult for them to prove. Furthermore, civil society has warned of indications that the registration data will be checked against data held by the immigration authorities.

See our blog on the situation in Hungary for more detailed information.

Italy

The Italian vaccination strategy doesn’t mention undocumented migrants explicitly. But the Italian Immigration Act (Testo Unico sull’Immigrazione) explicitly guarantees access to the vaccines as part of preventive public health care campaigns to all people living in Italy, including irregular migrants, besides any other urgent or essential health care. And the Italian Medicines Agency (Agenzia Italiana del Farmaco, AIFA) released guidelines which make clear that undocumented people are entitled to the COVID-19 vaccines.

However, challenges remain with practical access to the online booking systems, which are managed by Italy’s 20 regions.

See our blog on the situation in Italy for more detailed information.

Netherlands

The Dutch strategy explicitly mentions undocumented migrants as a group to be vaccinated, but only after priority groups based on age and health conditions. Today, undocumented migrants can book a COVID-19 vaccine via the mainstream booking system, homeless shelters and, in some cases, GPs.

See our blog on the situation in the Netherlands for more detailed information.

Norway

Undocumented migrants are not mentioned explicitly in the Norwegian vaccination strategy. However, under the law on communicable diseases, all people regardless of residence status are entitled to vaccinations. In addition, in spring 2021, the Norwegian Directorate of Health addressed a letter to all local and regional health authorities calling on them to make the vaccines available for everyone. However, the letter does not detail how to organise access to the vaccines for undocumented migrants in practice. In fact, booking an appointment for the vaccine requires a valid personal identification number, and being registered with a GP. Both are broadly unavailable to undocumented migrants. In large part, the chance of undocumented migrants being vaccinated is determined by the local municipalities and their motivation to find ways around bureaucratic barriers. The risk of immigration consequences when accessing the vaccines is virtually non-existent, since it’s illegal for medical staff to report undocumented patients.

See our blog on the situation in Norway for more detailed information.

Poland

According to FAQs on the vaccines published on the Polish government’s website, “Foreigners with the right to stay are vaccinated on the same terms as Polish citizens”, which implies that people with irregular status wouldn’t be included. Polish officials have further confirmed this on TV interviews. However, the Ministry of Health later stated that access to the vaccines does not depend on health insurance, which would allow undocumented migrants to get their shot.

Read our blog on Poland to understand legal and practical barriers to the vaccines.

Portugal

The Portuguese government launched an online platform which undocumented people living in the country can use to register for their COVID-19 vaccination, without need of a social security number. Although a welcome development, grassroots organisations have denounced the delay in establishing such a platform and fear that the lack of trust towards public authorities will prevent many from registering.

See our blog on the situation in Portugal for more detailed information.

Spain

According to the Spanish strategy, undocumented people are guaranteed equal access to the vaccines. But questions remain as to how public authorities will be able to reach this population.

United Kingdom

Government guidance states that the vaccines will be available for free for undocumented migrants, and no immigration check will be carried out in the context of the vaccination. But migrants rights groups say that practical barriers remain, including fears over fees and data sharing with immigration enforcement, because of the UK’s longstanding “hostile environment” policy that has sown distrust and insecurity, as well as the refusal of some GPs to register patients because they can’t provide certain information like proof of address, which isn’t legally required.

See our blog on the situation in the UK for more detailed information.Including undocumented people in national vaccination campaigns is essential to ensuring their success, and ultimately getting the pandemic under control. But measures limited to opening up access to the vaccine are not enough. The underlying factors that exclude undocumented people from accessing primary health care must be addressed – like burdensome administrative procedures, ineligibility for free or covered care, and exposure to immigration consequences for trying to access services.

Undocumented people are members of our communities, they are our neighbours, our friends. The pandemic has shown more clearly than ever that many work in situations of high risk that are too often undervalued – in care work, cleaning, agriculture. They have an equal right to be protected from this devastating pandemic. Ensuring access to health care for all is not only public health common sense, it is also and foremost the right thing to do.

Cover image: Adobe Stock – daniilvolkov

For undocumented people, the pandemic and related lockdown measures have exacerbated pre-existing conditions of social exclusion and deprivation.

Undocumented people are at high risk of getting COVID-19, especially if they are homeless or living in cramped, precarious conditions where physical distancing is hard to impossible. Some lost their jobs because of the pandemic, while many had to keep working – frequently in sectors that have become indispensable – often without adequate protection. Being undocumented means they are unlikely to qualify for non-emergency health care or for social or income protection schemes that are keeping others hit hard by the pandemic afloat.

As COVID-19 vaccination campaigns are starting to roll out across Europe, it is crucial that undocumented people are included.

In December 2020, the International Organisation on Migration issued a statement highlighting that, to be effective, COVID-19 vaccination plans must include migrants, and calling on governments to include all migrants present in their territories, regardless of their migration status, in their vaccine deployment plans.

At the end of 2020, the European Centre for Disease Prevention and Control also released two reports that consider migrants in relation to the COVID-19 vaccination campaigns. The first classifies “migrants and refugees” as potential target groups for the vaccination campaigns; the second advises that consideration should be given to settings with “little ability to physical distance” including migrant centres, crowded housing and homeless shelters.

In October 2020, the European Commission issued a Communication on vaccine preparedness, which includes “communities unable to physically distance” (such as “refugee camps”) and “vulnerable socioeconomic groups and other groups at higher risk” (such as “socially deprived communities to be defined according to national circumstances”) as “possible priority groups” for vaccines deployment. According to the communication:

”Member States will need to make decisions on which groups should have priority access to the COVID-19 vaccines so as to save as many lives as possible. These decisions should be driven by two criteria: to protect the most vulnerable groups and individuals, and to slow down and eventually stop the spread of the disease.”

Besides making the vaccines available to undocumented people on paper, countries need to make sure they get the vaccines in practice. What does this mean? As the IOM’s Director of Migrant Health has noted: ”As frontline health workers are prioritised, let’s not forget the countless migrant frontline health workers. As the elderly are prioritised, so should elderly migrants.” Similarly, efforts to reach people who are homeless or who are uninsured must reach, within these groups, people who are undocumented. Outreach plans need to account for the fact that for undocumented people, like others in situations of social vulnerability, financial hardship and administrative hurdles present real barriers to accessing mainstream care. More than that, the criminalisation of undocumented status means that many will avoid contact with government bodies, even if they are unwell or think they are sick.

It is, then, critical that the deployment of any COVID-19 vaccine to groups that include people who are undocumented or have insecure status has to be done in close cooperation with trusted community-based organisations that have a history of working with and providing services to them, and with the collaboration and direct involvement of individuals from these communities themselves. There must be clear assurances that any information informally or formally obtained about a person’s residence status in the course of providing care will not be used against them, to prompt immigration proceedings. And the absence of formal documentation cannot be a barrier to signing up for or getting a vaccine (or testing, for that matter).

Including undocumented people in national vaccination campaigns is not a luxury: it is necessary to ensure the success of vaccination programs, and ultimately getting the pandemic under control. But measures limited to opening up access to the vaccine are not enough. To ensure society’s resilience to similar shocks in the future, and to address the glaring cracks in our health and social welfare systems that have been exposed, governments need to adopt measures to remove systemic barriers to primary health care for all their residents, regardless of status, and ensure they are not forgotten and left to struggle alone when the next pandemic hits.

The European Commission has urged a recovery that builds resilience, that does not happen at the cost of ”the poorest people” – that ”will have to be inclusive and fair.” For this, Europe’s social policies must be disconnected from its restrictive migration policies so that all children, workers, families, individuals can get the services they need, without discrimination – in the context of this wretched pandemic, and beyond. The pandemic has shown us that this is the right thing to do, and the smart thing to do, for everyone.

If you have any information about national vaccination campaigns and undocumented people, please write to info@picum.org

Children enjoy special rights under the UN Convention on the Rights of the Child, regardless of their residence status. However, the transition of undocumented children into adulthood often comes abruptly: rights and basic services are no longer guaranteed and measures are not taken to support undocumented young adults in their new reality.

The European Commission is currently developing the EU Child Rights Strategy as part of its agenda for 2019-2024. The strategy aims to protect and promote children’s rights in the EU and to mainstream child rights in all relevant EU policy areas. It will serve as a policy framework that will cover all existing and future child rights policies under one umbrella. As President of the European Commission Ursula von der Leyen emphasized in her mission letter to Vice-President Šuica: “We need to invest more in the future of our children. ensuring that children have access to the services they need and are supported through to their adult lives”.

One of the policies proposed to reach this goal, which will receive funding as part of the EU Multiannual Financial Framework (MFF) for 2021-2027, is the Child Guarantee. This instrument is led by the Commission and backed by the Parliament, and will result in a non-binding Council Recommendation asking Member States to ensure “affordability, accessibility and availability of inclusive quality services for children in need.” By urging Member States to provide children and their parents access to essential services, such as healthcare, education and housing, the Commission aims to tackle poverty among children in need and improve their wellbeing and development.

If the aim of both the Strategy and the Guarantee is to establish a solid foundation for children that will provide life-long benefits, they should also address children’s transition into adulthood.

This is necessary because a clear binary approach can be observed in and practice at EU and Member State level upon a child’s 18^th birthday, when they no longer receive the protection and assistance they received until that moment. This approach is especially detrimental to undocumented children, children in migration and other children who are particularly vulnerable to poverty and marginalization and who need additional support and care from birth to ensure their development and wellbeing.

This can be seen in Belgium, where unaccompanied children can obtain a residence permit if the authorities find that residence in Belgium is in their best interests. However, if the Immigration Office has not determined the durable solution before the child turns 18, the procedure stops. A durable solution can be either integration in the host country, transfer to a third country (for example for reasons of family reunification) or return to the country of origin. From the moment the child turns 18, the now-young adult needs to prove that they fulfill the requirements (art. 61/24) for one of the regular pathways to residence, while they also lose their right to essential services and assistance such as education, healthcare, housing and financial support. In practice, these regularization pathways are further limited due to complex and ambiguous procedures and high application fees and costs for legal assistance.

This precarious transitioning of migrant children into adulthood is also referred to as “ageing out.” The term comes from the child protection context and generally refers to the situation where children lose rights and protections when they turn 18.

The Commission rightly acknowledges in its 2017 Communication on the protection of children in migration that children in state care should receive support to prepare for the transition to adulthood (i.e. thereby having to leave the state care facilities). However, both unaccompanied children and children living with their families – whether they are living in state care or not – age out as they lose the various rights and protections they were granted as children, including access to certain residence procedures. A systematic coaching mechanism is therefore essential, to ensure that all children (whether accompanied or unaccompanied) are supported during a transitory period, to prepare them for adulthood.

To ensure that the Commission’s Strategy on the Rights of the Child supports undocumented children in a sustainable way, PICUM calls on the Commission to:

1. Guarantee that the Child Rights Strategy and related policies and actions will benefit all children irrespective of residence status, to enable them to have the best possible start in life. As with other children, this includes preparing them for their transition to adulthood.
2. Ensure that both the Child Guarantee and the Youth Guarantee allow undocumented children who are about to age out to have continued access to extended services, including education, housing, healthcare and psychosocial support. Ensuring continued access to essential services will facilitate further social inclusion and help prevent them from becoming marginalized and exploited. During a transitory period, which should start before and continue after a child reaches the age of majority, all undocumented children should receive coaching to support them during their transition into adulthood.
3. Use EU funding for projects that support and coach children with a temporary or irregular residence status during a transitory period, to prepare them for adulthood. An example of this is the current call for proposals from the Asylum, Migration and Integration Fund, which includes a specific line on “migrant children’s transition to adulthood”.

PICUM has joined 27 international child rights organisations and Unicef in signing a joint position and addressing key recommendations to EU institutions and member states for the upcoming Child Rights Strategy, focusing amongst others on children in migration. You can read the full position paper here.

Image: Adobe Stock – Jacob Lund

The COVID-19 pandemic has affected all of us in our daily lives. However, different communities have been impacted in different ways. For undocumented people, one of the most marginalised communities in Europe, the pandemic and the lockdown measures have exacerbated pre-existing conditions of social exclusion and deprivation.

Some public authorities, at the national, regional and local levels, have adopted different measures, often temporary, to support undocumented people during these difficult times. These measures include regularisation, access to health care, financial assistance and more.

Click below to find out more in our non-exhaustive selection of such measures adopted between March and August 2020, inside and outside the European Union.